Insufflating optical surgical instruments

ABSTRACT

An insufflating surgical instrument adapted for movement across an abdominal wall to insufflate an abdominal region of a patient is disclosed comprising a shaft having an insufflation channel adapted for connection to a source of fluid under pressure at the proximal end, a tip at the distal end of the shaft, and at least one vent hole formed at the tip or the shaft being in connection with the insufflation channel and being adapted to expel the fluid under pressure to insufflate the abdominal region. At least one of the tip and the shaft is translucent or transparent to facilitate visualization of the abdominal region. The shaft includes a lumen extending along the axis between the proximal end and the distal end to enable insertion of a laparoscope. The lumen and insufflation channel may be formed as separate channels or as one shared channel.

This application is a continuation of non-provisional application Ser.No. 11/170,567, filed Jun. 29, 2005, entitled “Insufflating OpticalSurgical Instrument”, which is a non-provisional application claimingthe priority of provisional application Ser. No. 60/584,302, filed onJun. 29, 2004, entitled “Insufflating Optical Surgical Instrument,”which is fully incorporated herein by reference. This non-provisionalapplication is also filed as a continuation-in-part application claimingthe priority of patent application Ser. No. 10/956,167, filed on Oct. 1,2004, entitled “Bladeless Optical Obturator,” which is fullyincorporated herein by reference.

BACKGROUND OF THE INVENTION

1. Field of the Invention

This invention generally relates to surgical instruments and, inparticular, to surgical instruments providing visual entry and visualinsufflation.

2. Discussion of the Prior Art

Laparoscopic surgery of the abdominal area typically requires theintroduction of an insufflation gas into the peritoneal cavity of thepatient. The insufflation gas is usually pressurized to about 10 mm Hgabove atmospheric pressure. This in turn lifts the abdominal wall awayfrom the organs underlying it. Cannulas having seals are then placed atvarious locations through the abdominal wall to allow the use of alaparoscope and operating instruments. It is well known thatestablishing access to a non-inflated peritoneal cavity can be a verydangerous part of any laparoscopic procedure. The most common method toachieve insufflation is to pass a sharp needle through the abdominalwall and into the abdominal region, and then inject a gas through theneedle and into the region thereby creating an enlarged or balloonedcavity to accommodate a laparoscopic procedure. Unfortunately, insertionof the needle has been required without any visual aid to facilitatelocation of the sharp needlepoint. In order to reduce the probability ofinadvertent penetration of delicate internal organs in this “blind”procedure, the sharp insufflation needle has been provided with aspring-loaded and retractable safety mechanism.

The safety mechanisms associated with most insufflation needles consistof a blunt or rounded member disposed within the lumen of the needle,and biased by a spring to an extended position beyond the needle tip.This spring must be responsive to the insertion pressure duringplacement of the needle but must be capable of immediately movingforward when that pressure is relieved. This is a highly mechanicalevent at best and offers less than optimal arrangement. As pointed outabove, a drawback of this procedure is it is performed blindly. Aconsequence of this blind insertion is the surgeon may inadvertentlydamage the organs and tissues underlying the abdominal wall such asmajor blood vessels and the intestinal tract. Once access is gained, itcan take several minutes for the gas to insufflate the abdomen and whilethis is happening the surgeon may be unaware of any complications causedby the insertion of the needle.

Another commonly used method of gaining initial access to the peritonealcavity is by using a procedure known as the Hasson technique. Thismethod involves making a mini-laparotomy and using the fingers tobluntly dissect the tissues of the abdominal wall and thereby creatingan access similar to an open surgical procedure. This method isgenerally considered to be safer but not without risks, and results inan access site that is not well suited for the subsequent introductionand use of a laparoscopic cannula. The cannula is typically held inplace with an additional device that allows the cannula to be tied downwith sutures to prevent it from slipping out of the abdominal wall. Thisalso leaves a large defect and is difficult to perform in largeabdominal walls.

Some surgeons have used trocars designed for use with laparoscopes forthe initial entry into the peritoneal cavity. These devices allow theplacement of a laparoscope through the internal diameter of the trocarand have a trocar tip that is made of clear plastic to allow the surgeonto visualize the passage of the tip through the abdominal wall. However,in order to allow the subsequent introduction of insufflation gasthrough the cannula, the trocar and cannula must be inserted all the waythrough the wall of the abdomen and this in turn can be potentiallydangerous as the tip of the trocar may have to advance as much as oneinch beyond the distal surface of the abdominal wall and into theunderlying anatomical structures. As such, there remains a need in theart for an improved surgical instrument that provides visual entry andvisual insufflation, and that minimizes the risks of damaging organs,tissues and vessels underlying a body wall.

SUMMARY OF THE INVENTION

The invention is directed to surgical instruments providing visual entryand visual insufflation with minimal risks of injury to organs, tissuesand vessels underlying a body wall. It is appreciated that the conceptof the invention may be applied to any surgical instrument that providesthe ability to insufflate under direct vision of the site ofinsufflation, regardless of the size of the instrument and the type ofinsufflation fluid. More specifically, the surgical instrument providesthe ability to transfer an insufflation fluid such as CO₂ or saline fromoutside a patient to inside a surgical cavity under vision. Theinsufflation fluid may be transferred inside a lumen, along a bodychannel or through a coiled tube of a surgical instrument or scope usedfor vision.

In a first embodiment of the invention, an insufflating surgicalinstrument adapted for movement across an abdominal wall to insufflatean abdominal region of a patient is disclosed comprising a shaft havingan insufflation channel extending along an axis between a proximal endand a distal end, the insufflation channel being adapted for connectionto a source of fluid under pressure at the proximal end. Theinsufflating surgical instrument further comprises a tip at the distalend of the shaft and at least one vent hole formed at the tip or theshaft being in connection with the insufflation channel and beingadapted to expel the fluid under pressure to insufflate the abdominalregion. In one aspect, at least one of the tip and the shaft is formedof a transparent material to facilitate visualization of the abdominalwall and the abdominal region. With this aspect, the shaft and the tipare configured to enable insertion of a laparoscope. In particular, theshaft includes a lumen extending along the axis between the proximal endand the distal end to enable insertion of the laparoscope. The lumen andinsufflation channel may be formed as separate channels or as one sharedchannel. The insufflating surgical instrument may further comprise asecond vent hole being in connection with the insufflation channel andformed along the shaft. It is appreciated that the tip may be blunt, theshaft and the tip may be integrally formed, and the vent hole may be ofany geometric shape including round, oval, square and rectangular. Withthis aspect, at least one of the tip and the shaft may be formed of atranslucent or a transparent material such as polycarbonate. The blunttip may further comprise a marker to indicate when the vent hole hasbeen positioned for insufflation. More specifically, the markerindicates the point where the vent hole has penetrated the abdominalwall. The shaft of the invention may further comprise a scope lock toprevent the laparoscope from being inserted too far into the shaft andblock at least one of the insufflation channel and the vent hole. Inanother aspect, the tip may be sharp, pointed or bladed to facilitatepenetration of body tissue.

The insufflating surgical instrument may further comprise a seal housingdisposed at the proximal end of the shaft. The seal housing comprises aseptum seal and a plurality of leaflets forming an instrument seal inthe presence of a laparoscope, and providing a zero seal in the absenceof an instrument. The thickness of the leaflets may be formed to adesired dimension to create a pressure release mechanism that invertsand releases pressure if the abdominal pressure within the patientundergoes a sudden spike. The septum seal may be formed of anelastomeric material including Kraton, silicone and the like. The sealhousing may further comprise a duckbill or a double duckbill valvedistal of the leaflets to further limit gas or fluid escape.

In another aspect of the invention, an insufflating surgical instrumentadapted for penetrating an abdominal wall to insufflate an abdominalregion of a patient is disclosed comprising a shaft having aninsufflation channel extending along an axis between a proximal end anda distal end, the insufflation channel being adapted for connection to asource of fluid under pressure at the proximal end. The insufflatingsurgical instrument further comprises a tip at the distal end of theshaft, the tip having a first, closed position during penetration of theabdominal wall and a second, opened position to expel the fluid underpressure to insufflate the abdominal region after penetration of theabdominal wall. The tip may be a flip-top that automatically opens upontraversing the abdominal wall or a flapper valve that opens to thesecond position when gas or fluid is introduced at the source and intothe insufflation channel. The insufflating surgical instrument mayfurther comprise a retention member for connecting the shaft and theflip-top. The flip-top may be a two-piece flip-top, the flapper valvemay be a reverse flapper valve or a spring-based flapper valve, and theretention member may be one of a spring, a spring wire, an offset hingeor a living hinge. In another aspect, the tip may comprise at least twopetals that reposition to the side of the shaft in the secondinsufflation position.

Another aspect of the invention is a laparoscopic insufflating surgicalinstrument adapted for movement across an abdominal wall to insufflatean abdominal region of a patient comprising an elongate tube having adistal tip, an insufflation channel extending between a proximal end anda distal end, the elongate tube being adapted for connection to a sourceof fluid under pressure at the proximal end, and being adapted at thedistal end to expel the fluid under pressure to insufflate the abdominalregion, and an optical element disposed at the distal end of theelongate tube to facilitate visualization of the abdominal wall and theabdominal region. With this aspect, the distal tip is defined by acurved surface, the distal tip being translucent or transparent, and theoptical element being a light or an endoscope. It is appreciated thatthe insufflating surgical instrument may be an insufflating Veressneedle.

Another aspect of the invention is directed to a laparoscopicinsufflating surgical instrument adapted for movement across anabdominal wall to insufflate an abdominal region of a patient comprisingan elongate tube having a proximal end and a distal end, an opticalelement disposed at the distal end of the elongate tube to facilitatevisualization of the abdominal wall and the abdominal region of thepatient, and an insufflation channel having a proximal end and a distalend extending along the proximal end and the distal end of the elongatetube, the insufflation channel being adapted for connection to a sourceof fluid under pressure at the proximal end, and to expel the fluidunder pressure to insufflate the abdominal region at the distal end.With this aspect, the insufflation channel is formed into a coil aroundthe elongate tube. It is further appreciated that the distal end of theelongate tube may be tapered to form a generally cone-tipped end.

In yet another aspect of the invention, there is disclosed aninsufflating surgical instrument adapted for movement across anabdominal wall to insufflate an abdominal region of a patient, thesurgical instrument comprising an insufflating cannula having a wallforming a first lumen extending along an axis between a proximal end anda distal end, and a first insufflation channel formed in the wallextending along the axis between the proximal end and the distal end andbeing adapted for connection to a source of fluid under pressure at theproximal end. The insufflating surgical instrument further comprises aninsufflating trocar having a shaft with a second lumen extending alongthe axis between a proximal end and a distal end, a second insufflationchannel formed at the distal end and being adapted for alignment withthe first insufflation channel of the cannula to expel the fluid underpressure to insufflate the abdominal region, and a tip at the distal endof the shaft, and at least one vent hole formed at the tip of the trocarbeing in connection with the second insufflation channel of the trocar.The insufflating surgical instrument may further comprise a laparoscopeadapted for insertion at the proximal end of the trocar and advanced tothe distal end as the trocar is placed through the abdominal wall.

Another aspect of the invention is directed to a method for using aninsufflating surgical instrument to create access across an abdominalcavity and to insufflate an abdominal region of a patient, the methodcomprising providing a transparent shaft having a lumen and aninsufflation channel extending along an axis between a proximal end anda distal end, the insufflation channel being adapted for connection to asource of fluid under pressure at the proximal end, a tip at the distalend of the shaft, and at least one vent hole formed at the tip or theshaft being in connection with the insufflation channel and adapted toexpel the fluid under pressure to insufflate the abdominal region;moving the shaft across the abdominal wall to place the distal end ofthe shaft in the abdominal region; and expelling gas or fluid underpressure through the insufflation channel to insufflate the abdominalregion of the patient. The method for using the insufflating surgicalinstrument may further comprise the step of visualizing the abdominalcavity through the lumen of the shaft.

These and other features of the invention will become more apparent witha discussion of the various embodiments in reference to the associateddrawings.

DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are included in and constitute a partof this specification, illustrate the embodiments of the invention and,together with the description, explain the features and principles ofthe invention. In the drawings:

FIG. 1 illustrates a typical laparoscopic abdominal surgery of the priorart;

FIG. 2 illustrates a perspective view of an insufflation needle of theprior art;

FIG. 3 illustrates a perspective view of an insufflating optical trocarin accordance with a first embodiment of the invention;

FIGS. 4( a) and 4(b) illustrate cross-sectional views of an insufflatingoptical trocar in accordance with another embodiment of the invention;

FIG. 5 illustrates a perspective view of a septum seal for use with theinsufflating optical trocar of the invention;

FIG. 6( a)-6(d) illustrate cross-sectional views of the septum seal foruse with the insufflating optical trocar of the invention;

FIGS. 7( a) and 7(b) illustrate the insufflating optical trocar andcannula of the invention;

FIGS. 8( a)-8(f) illustrate different geometric shapes and patterns ofthe vent hole of the invention;

FIG. 9 illustrates an insufflating needle having a transparent distaltip and insufflating vent in accordance with another embodiment of theinvention;

FIG. 10 illustrates an insufflating scope having a transparent distaltip and insufflating vent in accordance with another embodiment of theinvention;

FIG. 11 illustrates an insufflating scope sleeve having a transparentdistal tip and insufflating vent in accordance with another embodimentof the invention;

FIGS. 12( a)-12(f) illustrate additional tip designs of an insufflatingoptical surgical instrument in accordance with additional aspects of theinvention;

FIGS. 13( a) and 13(b) illustrate a coiled insufflating optical trocarand a coiled insufflating optical trocar with a coiled tip,respectively, in accordance with additional embodiments of theinvention;

FIGS. 14( a)-14(c) illustrate flip-top or flip-tip designs ofinsufflating optical surgical instruments in accordance to additionalembodiments of the invention;

FIGS. 15( a)-15(c) illustrate cross-sectional views of insufflatingvalve vents in accordance with additional embodiments of the invention;

FIG. 16 illustrates a blunt tip insufflating optical instrument havingan advanceable lumen in accordance with another embodiment of theinvention;

FIGS. 17( a) and 17(b) illustrate an insufflating surgical instrumentincluding an insufflating optical trocar and a cannula having a gaschannel for transferring insufflation gas to the trocar in accordancewith another embodiment of the invention;

FIG. 18 illustrates an insufflating blade actuating optical trocar inaccordance with another embodiment of the invention; and

FIGS. 19( a)-19(i) illustrate additional tip designs in accordance toother aspects of the invention to facilitate penetration of body tissue.

DESCRIPTION OF THE INVENTION

Referring to FIG. 1, there is shown a typical laparoscopic abdominalsurgery where an inflation needle 10 is inserted through a body orabdominal wall 15 and into an abdominal cavity 25. A gas is passedthrough the needle 10 to create a space within the abdominal cavity 25.This procedure is referred to as insufflation. The needle 10 is referredto as an insufflation needle and the gas supply is referred to as aninsufflation gas. The insufflation needle 10 is placed through the bodywall 15 blindly. In other words, there is no direct visualization of theprocedure from the inside of the body wall 15. As explained earlier, thecurrent procedure may inadvertently damage organs and tissues underlyingthe body or abdominal wall 15 such as major blood vessels and theintestinal tract. It is not uncommon for there to be internal structuresattached to the internal side of the body wall 15. This is especially soin the case of the abdominal cavity 25. Portions of the intestines,colon and bowel may be attached to the abdominal wall 15. Theseattachments are referred to as adhesions.

Adhesions represent a potential complication in laparoscopic surgery.This is especially the case as the procedure is initiated using a sharpor pointed instrument such as the insufflation needle 10. The delicateinternal structures that may be attached by adhesions may inadvertentlybe pierced by the introduction of the insufflation needle 10. This canbe very serious and may go undetected for some time.

Referring to FIG. 2, the typical insufflation needle 10 comprises anelongate tubular body 12, a proximal connecting housing 14, a sharp,pointed distal tip 16 and a spring, biased internal blunt core 18 with ablunt end 24 that extends beyond the sharp distal tip 16 under theinfluence of an extended compression spring 20. A typical placement ofthe insufflation needle 10 requires a user to push the sharp distal tip16 into the abdominal wall 15, which pushes the blunt core 18proximally, then continues to push until the distal end 22 is throughthe body wall 15. At that point, the blunt end 24 moves forward andthereby protects delicate structures from being inadvertently puncturedby the sharp distal tip 16 of the needle 10. The safety of such a devicedepends to a large extent on the design and integrity of the spring 20since the sharp distal tip 16 remains within the established internalregion or body cavity 25

Referring to FIG. 3, there is shown a perspective view of aninsufflating optical instrument or trocar 30 in accordance with a firstembodiment of the invention. The insufflating optical trocar 30 isdesigned to separate tissue fibers during insertion through the bodywall 15. The insufflating optical trocar 30 includes a shaft 34 having alumen extending substantially along an axis between a proximal end and adistal end, a handle 35 disposed at the proximal end of the shaft 34,and a blunt tip 32 disposed at the distal end of the shaft 34. The shaft34 of the insufflating optical trocar 30 is sized and configured fordisposition within a working channel of a cannula system as described inco-pending application Bladeless Optical Obturator, which is hereinincorporated by reference. With this disposition, the insufflatingoptical trocar 30 functions to penetrate a body or abdominal wall toprovide the cannula with access across the body wall 15 and into thebody cavity 25, such as the peritoneal or abdominal cavity.

In one aspect of the invention, the shaft 34 and tip 32 are integrallyformed of a transparent material to enable visualization of tissueduring the insertion of the insufflating optical trocar 30 through thebody wall 15. The insufflating optical trocar 30 is configured to enablethe insertion of a conventional laparoscope, which typically includes animaging element and fiber optic light fibers. The tip 32 furtherincludes at least one vent hole 36, and preferably two or more ventholes one on each side of the tip 32, for the insufflation gas totransfer from the inside of the trocar 30 into the body or abdominalcavity 25. The vent hole 36 may be chamfered on the proximal side suchthat the vent hole does not core tissue as the insufflating opticaltrocar 30 enters through the body wall 15

The shaft 34 includes at least one shaft vent 38 and preferably aplurality of shaft vents 38 along the axis between the proximal end andthe distal end. It is appreciated that vent holes 36 and shaft vents 38may be of any geometric shape including round, oval, square,rectangular, etc, as illustrated in FIGS. 8( a)-8(c) and may beconfigured in different patterns such as a waffle pattern as illustratedin FIG. 8( f). Furthermore, the tip 32 may be an open tip 180 or anon-coring tip 182 as illustrated in FIGS. 8( d) and 8(e), respectively,to allow the transfer of insufflation gas into the body cavity 25.Advantages of the shaft vents 38 include supporting a plurality of corepins during the injection molding process of the shaft 34 to provide auniform part thickness, and allowing the insufflation gas to transferfrom the inner diameter of the cannula and seal housing into the innerdiameter of the insufflating optical trocar 30 and consequently out ofthe vent holes 36 at tip 32

Referring to FIGS. 4( a) and 4(b), there are shown side cross-sectionalviews of an insufflating optical trocar 40 in accordance with anotherembodiment of the invention. The insufflating optical trocar 40 includesa shaft 34 b having a lumen extending substantially along an axisbetween a proximal end and a distal end, and a blunt tip 32 b disposedat the distal end. The insufflating optical trocar 40 further includesat least one gas channel 42 extending along the length of the shaft 34 bto provide rapid gas transfer through the insufflating optical trocar 40when a scope has been placed within the inner diameter. It isappreciated that there may be more than one gas channel 42 extendingalong the length of the shaft 34 b to provide rapid gas transfer throughthe trocar 40. It is further appreciated that the gas channel 42 may beformed as a separate channel or as the same channel for inserting thescope, that is, by increasing the inner diameter of the shaft 34 b to bebigger than the diameter of the scope. More specifically, even if thescope and gas share the same channel, the gas channel 42 assures thatthere is sufficient cross-sectional area for the gas to travel along theside of the scope and down to the vent hole(s) 36 b even when the scopeis in place.

The tip 32 b may further include a marker 46 to be used as a visiblereference point. The marker 46, together with an area indicated byreference number 44 as shown in FIG. 4A, depict the down vent of theinsufflating optical trocar 40 that transfers the gas from the gaschannel 42 of the trocar 40 to the vent holes 36 b at tip 32 b. Forexample, as the trocar 40 is being placed through the abdominal wall 15,at some point the tip 32 b of the trocar 40 will penetrate theperitoneum. Once the peritoneum can be seen through the tip 32 b andonce the peritoneum is above the visible marker 46, the insufflation gascan be turned on and insufflation can begin. As such, this marks thepoint where the vent hole 36 b is within the abdominal cavity. Once theinsufflation gas has created sufficient space between the abdominal walland the organ bed, the remainder of the insufflating optical trocar 40including the cannula system can then be fully inserted to an operativeposition.

The insufflating optical trocar 40 may further include a scope stop 48as illustrated in FIG. 4( b) to keep a scope from being inserted intothe taper of the inner diameter of the trocar 40. The scope stop 48 mayfurther include a ledge that further prevent the possibility of thescope from being inserted too far into the trocar and consequently blockthe distal portion of the gas channel 42.

Referring to FIG. 5, there is shown a perspective view of a septum seal50 to be used with the insufflating optical trocar of the invention. Theseptum seal 50 includes a tubular body 52, a septum ring 53 and aplurality of leaflets 54 formed by a slit 56 providing an instrumentseal when a scope is inserted into the insufflating optical trocar and azero seal when the scope is withdrawn from the trocar. In addition, thethickness of the leaflets 54 can be controlled such that a pressurerelease mechanism can be created and consequently allowing the leaflets54 to invert and release pressure if the abdominal pressure within thepatient undergoes a sudden spike. Referring to FIGS. 6( a)-6(d), thereare shown cross-sectional views of the septum seal 50 of FIG. 5. Theseptum seal 50 further includes a retaining ledge 58, which allows theseptum seal 50 to be attached to the cap or handle 35 of theinsufflating optical trocar, and also serves as a sealing surface.Reference number 59 illustrates a sealing surface between the septumseal 50 and the cap or handle of the insufflating optical trocar. Theseptum seal 50 may further comprise a duckbill or double duckbill valveplaced distally of the leaflets 54 to further limit gas or fluid escape.

During use, the insufflating optical trocar 30 is first inserted into aseal housing 84 and cannula 70 as illustrated in FIG. 7( a). Aconventional laparoscope 72 is then inserted into the proximal end ofthe insufflating optical trocar 30 and advanced to the distal end of thetrocar 30. An endoscopic video camera is attached to the proximal end ofthe laparoscope 72. The trocar 30 is then axially advanced by thesurgeon through the body wall 15. As the surgeon advances the cannula 70and trocar 30 through the body wall 15, the surgeon can visually observetissue of the body wall 15 as it is being separated via a video monitor,which is connected to the endoscopic video camera. The surgeon can alsoreadily determine when the body wall 15 has been completely traversed bythe trocar 30. Once the trocar 30 has traversed the body wall 15, thetrocar 30 and laparoscope 72 may be removed which leaves the cannula 70disposed across the body wall 15 to provide an access channel into thebody cavity 25 for the insertion of laparoscopic instrumentation.

As illustrated in FIG. 7( a), the insufflating optical trocar 30 isdesigned for use with the seal housing 84 and cannula 70. The tip 32 maybe blunt and does not include any sharp edges, piercing points orblades. With this aspect of the invention, the tip 32 of the bladelessinsufflating optical trocar 30 is transparent and generally hollow. Thisenables a clear view through the distal tip of the insufflating opticaltrocar 30 and increases the visibility of tissue as it is beingtraversed. The obturator shaft 34 with the integral tip 32 may be formedof a transparent material such as polycarbonate. The septum seal 50,which may be formed of a material such as Kraton, silicone and the like,may be snap fitted onto the proximal end of the obturator shaft 34. Theseal housing 84 may further include a handle attachment 35 including acannula seal, which may be formed of a plastic material such aspolycarbonate, that operates to attach the trocar 30 to the cannula 70so as to maintain axial position during insertion. The diameter of theshaft 34 can range from about 2 mm to 50 mm and is designed to fitwithin the seal housing 84 and cannula 70.

Referring to FIG. 7( b), the cannula 70 is designed to releasably attachto the seal housing 84 via cannula seal 80 a, 80 b. As the shaft 34 isinserted into the seal housing 84 and cannula 70, the cannula seal 80 a,80 b passively engages the seal housing 84 and serves to axially lockthe shaft 34 to the seal housing 84 and cannula 70. To release the shaft34 from the seal housing 84 and cannula 70, outboard tabs on shaft 34are depressed inwardly and the shaft 34 is then free to be slidablyremoved. The shaft 34 includes axial key members 37 (see FIG. 3) at itsproximal end which are designed to mate with axial keyways on the sealhousing 84. As the shaft 34 is inserted into the seal housing 84 andcannula 70, the shaft 34 is rotated slightly to align key members 37with the keyways and then advanced until the cannula seal 80 a, 80 bengages the seal housing 84. The key members 37 serve to rotationallyindex the shaft 34 to the seal housing 84. In another aspect, cannula 70may further include distal cannula seal 82 formed at a distal portion ofcannula 70 and shaft 34 so as to further limit gas or fluid escape.

In another aspect of the invention, the insufflating optical trocar 30may include a laparoscope lock 86 having an elastomeric element. Theaddition of the elastomeric element would enhance the frictionalengagement with the laparoscope 72. An example of an elastomeric elementwould be a silicone O-ring sized with an inside diameter smaller thanthe outside diameter of the laparoscope 72. The laparoscope lock 86could either rotate freely to enable the laparoscope 72 to rotate freelyrelative to the shaft 34 or the laparoscope lock 86 could berotationally fixed to prevent the laparoscope 72 from rotating relativeto the shaft 34.

In another aspect of the invention, a process of placing and using theinsufflating optical trocar of the invention is described. First, theskin around the area to be operated on is incised appropriately for thesize of the cannula 70. An insufflation gas line 90, which is attachedto the seal housing 84, the insufflating optical trocar 30 and thelaparoscope 72 are then inserted into the cannula 70. At this point thegas supply is still turned off. The assembled device is then advancedthrough the body or abdominal wall 15 under direct vision until it isobserved that just the tip 32 of the device has penetrated theperitoneal cavity. The device is then held in place and the flow ofinsufflation gas is begun. The gas will flow through the tip 32 and intothe peritoneal cavity until the cavity is sufficiently distended by gaspressure. The surgeon then completes the insertion of the insufflatingoptical trocar 30 until the cannula 70 is in an appropriate or desiredposition. The insufflating optical trocar 30 and laparoscope 72 may thenbe removed. At this point, the surgeon may elect to reinsert just thelaparoscope 72 through the seal housing 84 and thereby allow observationof the abdominal cavity and subsequent insertions of additionallaparoscopic instrumentation.

As explained earlier, an indicator line or marker 46 as shown in FIG. 4(a) may be located on tip 32 to be viewed by laparoscope 72 to indicatewhen the device has advanced far enough into the body cavity to begininsufflation. The coincidence of anatomical features with the indicatorline or marker 46 may indicate the correct position to begininsufflation. The indicator line or marker 46 could be circumferentialin nature and when the peritoneal layer, as it is being penetrated,forms a coincident circle with respect to the indicator line 46, thesurgeon can begin insufflating. Another method is to employ an O-ringseal 86. Additionally, it is preferred that a zero seal be present onthe trocar to prevent escape of the gas when the trocar is used to placecannulas without the laparoscope 72. A double duckbill valve 88 wouldwork well too for this application as would a single duckbill, a flappervalve or a slit valve.

It is appreciated that the above-described concept may be applied to anysurgical instruments providing visual entry and visual insufflation,regardless of size or type of fluid transfer as further described in thefollowing exemplary embodiments of the invention. For example, FIG. 9illustrates an insufflating needle 190 in accordance with another aspectof the invention comprising an elongate tubular body 192 having aninsufflation channel extending along an axis between a proximal end anda distal end, a transparent distal tip 194 operably attached to thedistal end of the tubular body 192, and at least one insufflating venthole 196 formed at the distal tip 194 or tubular body 192 and being inconnection with the insufflation channel. The insufflating needle 190may further include an insufflation-controlling device 198 such as astopcock and a sealing mechanism 200 at the proximal end of the tubularbody 192. A small diameter scope 202 may be inserted at the proximal endof the tubular body 192 and then advanced to the distal end of thetubular body 192 as the insufflating needle 190 such as an insufflatingVeress needle is placed through an abdominal wall in yet another aspectof the invention as illustrated in FIG. 10, an insufflating scope 210comprises an elongate body 212 having an insufflation channel 224extending along an axis between a proximal end and a distal end, atransparent tip 214 operably attached to the distal end of the elongatebody 212 and having at least one insufflating vent hole 216 being inconnection with the insufflation channel 224, and a handle 218 formed atthe proximal end of the elongate body 212. The insufflating scope 210may further include an insufflation-controlling device 220 such as astopcock at the proximal end of the elongate body 212 or on the handle218. The elongate body 212 includes an optical element 222 that directslight to the tip 214 and at least one insufflation channel 224 totransfer the insufflation gas into the surgical cavity.

Referring to FIG. 11, there is shown an insufflating scope sleeve 230 inaccordance with another embodiment of the invention. The insufflatingscope sleeve 230 comprises a flexible sleeve 232 having a proximal endand a distal end, a transparent tip 234 operably attached to the distalend of the flexible sleeve 232 and having at least one insufflating venthole 236, and a handle 238 attached to the proximal end of the flexiblesleeve 232. The insufflating sleeve 230 may further include aninsufflation-controlling device 240 such as a stopcock and a sealingmechanism 242 at the proximal end of the insufflating sleeve 230. Ascope 244 may be inserted at the proximal end of the insufflating scopesleeve 230 and then advanced to the distal end of the insufflating scopesleeve 230 as the insufflating scope sleeve 230 is placed through anabdominal wall.

Referring to FIGS. 12( a)-12(f), there are shown additional tip designs32 o-32 s in accordance with other aspects of the invention tofacilitate penetration of a body tissue. FIG. 12( a) illustrates aspoon-shaped or asymmetric tip 32 o having at least one vent hole 36 o;FIGS. 12( b) and 12(c) illustrate a generally domed or conical shapedtip 32 p having plastic or metal blades 33 p along an axis of the shaftand at least one vent hole 36 p; FIG. 12( d) illustrates a blunt tip 32q having at least one vent hole 36 q; FIG. 12( e) illustrates agenerally domed or conical shaped tip 32 r having at least one bladedfin 33 r and at least one vent hole 36 r; and FIG. 12( f) illustrates agenerally conical shaped tip 32 s having at least one vent hole 36 s atthe distal tip. It is appreciated that tips 32 o, 32 p, 32 r and 32 shave a sharp, pointed or bladed tip and/or edge to facilitatepenetration of body tissue. In yet other aspects of the invention, thesurface of the tip may have at least one tissue engaging raised patternon the surface. The surface operates to facilitate insertion of theinsufflating surgical instrument or optical trocar with a reducedpenetration force and minimize tenting of the body wall. The surface mayfurther facilitate separation of different layers of the body wall andprovides proper alignment of the tip between the layers. In anotheraspect of the invention, the tip may have an outer surface extendingdistally to a blunt point and includes a pair of side sections separatedby an intermediate section, and wherein the side sections extend fromthe blunt point radially outwardly with progressive positions proximallyalong the axis. The side sections may include a distal portion inproximity to the blunt point and a proximal portion in proximity to thetubular body, and the distal portion of the side sections being twistedradially with respect to the proximal portion of the side sections.

FIGS. 13( a) and 13(b) illustrate a coiled insufflating optical trocar250 and a coiled insufflating optical trocar with a coiled tip 260,respectively, in accordance with additional embodiments of theinvention. The coiled insufflating optical trocar 250 comprises a shaft34 t having a lumen and a hollow coiled tube or gas channel 42 t wrappedsubstantially along the length of the shaft 34 t to provide gas transferinto the body cavity. An advantage of this aspect of the invention iscoiling also helps to keep the trocar from moving about inside a bodycavity. The coiled insufflating optical trocar 250 may further includean insufflation-controlling device 240 such as a stopcock at theproximal end of the coiled insufflating optical trocar 250. A scope maybe inserted at the proximal end of the coiled insufflating opticaltrocar 250 and then advanced to the distal end of the trocar 250 as thetrocar 250 is placed through an abdominal wall. The coiled insufflatingoptical trocar with coiled tip 260 as shown in FIG. 13( b) is similar tothe coiled insufflating optical trocar 250 but further includes a tip 32u and a hollow coiled tube or gas channel 42 u that wraps around the tip32 u and substantially along the length of the shaft 34 u.

Referring to FIGS. 14( a)-14(c), there are shown additional tip designs32 v-32 x in accordance to other aspects of the invention. For example,the tip 32 v as illustrated in FIG. 14( a) comprises a flip-top 272 anda conical body 270 that operates to move from a first, penetratingposition to a second, insufflating position when the body wall has beentraversed. The tip 32 v may further comprise a retention member forconnecting the flip-top 272 and the conical body 270. The retentionmember may be one of a spring, a spring wire, an offset hinge or a“living” hinge. Other flip-top or flip-tip designs as described inco-pending U.S. patent application Ser. No. 10/805,864, entitled“Surgical Access Port and Method of Using Same,” filed Mar. 22, 2004,which is herein incorporated by reference, may also be used with theinsufflating concept of the invention. In yet another aspect of theinvention, the tip 32 w as illustrated in FIG. 14( b) comprises atwo-piece flip-top 282 a, 282 b that operates to move from a first,penetrating position to a second, insufflating position when the bodywall has been traversed. In particular, the tip 32 w may comprise atleast two or more parts or petals that reposition to the side of theshaft 34 w in the second, insufflating position. FIG. 14( c) illustratesthe tip 32 x in accordance with another aspect of the inventioncomprising a two-stage flip-top 290 that operates to move from apenetrating position to an insufflating position and then to aninstrument access position. In particular, the two-stage flip-top 290comprises a distal flip portion 292 and a proximal flip portion 294. Inthe first stage, the distal flip portion 292 moves from a penetratingposition to an open or insufflating position once the body wall has beentraversed. Once insufflation has been achieved, the proximal flipportion 294 moves to an open or instrument access position in the secondstage. The tip 32 x may further comprise retention members forconnecting between the distal flip portion 292 and the proximal flipportion 294, and between the proximal flip portion 294 and the shaft 34x.

FIGS. 15( a)-15(c) illustrate insufflating valve vents in accordancewith additional aspects of the invention. More specifically, FIG. 15( a)illustrates an insufflating valve vent 300 formed at the distal end ofthe shaft 34. The insufflating valve vent 300 is formed of an elasticmaterial to allow gas such as CO₂ to be introduced from the inside ofthe shaft 34 to a body cavity. It is appreciated that when there is nogas, the elastic material of the insufflating valve vent 300 causes itto close so as to provide an airtight seal FIG. 15( b) illustrates aninsufflating flapper valve 310 formed at tip 32 y of an insufflatingoptical trocar. The insufflating flapper valve 310 comprises at leastone flapper valve vent 312 that operates to open when a gas such as CO₂is introduced in the shaft 34. It is appreciated that when there is nogas, the flapper valve vent 312 closes to provide a tight seal.Similarly to FIG. 15( b), FIG. 15( c) illustrates an insufflatingreverse flapper valve 320 formed at tip 32 z of an insufflating opticaltrocar. The insufflating reverse flapper valve 320 comprises at leastone flapper valve vent 322 that remains close or shut by tissue duringinsertion, and once peritoneum is passed, pressure by a gas such as CO₂would then open the reverse flapper valve 320 to allow the transfer ofthe gas into a body cavity. It is appreciated that each of the aboveflapper valve vents may be spring loaded to operate like a Veressneedle.

FIG. 16 illustrates a blunt tip insufflating optical instrument 400 inaccordance with another embodiment of the invention. The blunt tipinsufflating optical instrument 400 comprises an elongate tubular body410 extending along an axis between a proximal end and a distal end, ablunt tip optical obturator or separator 420 to be inserted through thetubular body 410 and into a body cavity, and an advanceable insufflationchannel 430 extending along the length of the tubular body 410 and intothe body cavity. The blunt tip optical obturator or separator 420operates to provide visibility down to the peritoneum at which time theinsufflation channel 430 may be advanced through the peritoneum toprovide gas and/or saline to the body cavity until sufficient space isachieved. Once gas and/or saline have been sufficiently introduced, theblunt tip optical obturator 420 and tubular body 410 may be advancedinto the body cavity. A feature of this aspect of the invention is theinsufflation channel 430 may be advanced ahead of the blunt tip opticalobturator or separator 420 to puncture peritoneum to transfer gas suchas CO₂ to the body cavity.

Referring to FIGS. 17( a) and 17(b), there are shown illustrations of aninsufflating surgical instrument 500 in accordance with anotherembodiment of the invention. The insufflating surgical instrument 500comprises an insufflating optical trocar 502 and a cannula 520. Theinsufflating optical trocar 502 comprises a shaft 504 having a lumenextending along an axis between a proximal end and a distal end, a tip506 disposed at a distal end of the shaft, at least one vent hole 508 tointroduce gas from the cannula 520 into the body or abdominal cavity asfurther discussed below, and a gas channel 510 formed in either theshaft 504 or the tip 506 and operably connected to the at least one venthole 508 to allow gas transfer from the cannula 520 to the insufflatingoptical trocar 502. The cannula 520 comprises at least one cannula gaschannel 522 extending along its longitudinal axis to transfer gas to thetrocar gas channel 510 after insertion of the insufflating opticaltrocar 502 into the cannula 520. In other words, the cannula gas channel522 is encased as a lumen in the cannula wall. During operation, thetransfer of gas only takes place if there is an alignment between thecannula gas channel 522 and the trocar gas channel 510 as illustrated inFIGS. 17( a) and 17(b) A scope 525 may be inserted at the proximal endof the insufflating optical trocar 502 and then advanced to the distalend of the trocar 502 as the trocar 502 is placed through an abdominalwall.

In yet another aspect of the invention, FIG. 18 illustrates aninsufflating blade actuating optical instrument 600 in accordance withanother embodiment of the invention. The insufflating blade actuatingoptical instrument 600 comprises an elongate tubular member 602extending along a longitudinal axis between a proximal end and a distalend, an optical member 604 operably attached at the distal end of theelongate member 602, at least one blade member 606 being longitudinallymovable between deployed and nondeployed positions, an actuatingmechanism 608 operably attached at the proximal end of the tubularmember 602 for moving the blade member 606 between the deployed andnondeployed positions, and at least one insufflating vent 610 formed inthe optical member 604 to transfer insufflation gas from outside a bodycavity to inside the body cavity. A scope may be inserted at theproximal end of the insufflating blade actuating optical instrument 600and then advanced to the distal end of the instrument 600 as theinsufflating blade actuating optical instrument 600 is placed through anabdominal wall.

Referring to FIGS. 19( a)-19(i), there are shown additional tip designs32 aa-32 ii in accordance to other aspects of the invention tofacilitate penetration of a body tissue. Each of these tip designsincludes at least one vent hole (36 aa-36 ii) at the distal tip tointroduce insufflation gas into a body cavity. It is appreciated thatsome of these tips have a sharp, pointed or bladed tip and/or edge tofacilitate penetration of body tissue.

It is appreciated that the above described surgical instruments anddevices can be used to access not only the peritoneal cavity but can beused for preperitoneal hernia repair, retroperitoneal operationsincluding back and kidney operations, percutaneous kidney operations,thoracic surgery and arthroscopic access. In addition to gas such ascarbon dioxide, it is appreciated that other fluids such as air, waterand saline can also be introduced into a body cavity with the techniqueof the invention. It is appreciated that operating scopes may bemodified such that a lumen may be used to introduce insufflation fluid.Accordingly, it is understood that many other modifications can be madeto the various disclosed embodiments without departing from the spiritand scope of the invention. For these reasons, the above descriptionshould not be construed as limiting the invention, but should beinterpreted as merely exemplary embodiments.

The invention claimed is:
 1. An insufflating surgical instrument adaptedfor movement across an abdominal wall to insufflate an abdominal regionof a patient, comprising: a cannula comprising a wall forming a lumenextending along an axis between the proximal end and a distal end andadapted for connection to a source of fluid under pressure at theproximal end; and a trocar insertable into and removable from the lumenof the cannula; the trocar comprising: a shaft having a wall forming alumen extending between a proximal end and a distal end; and aninsufflation channel configured such that fluid from the cannula flowsinto the trocar; a tip at the distal end of the shaft enclosing thedistal end of the shaft; and at least one vent hole formed at the tip oralong the shaft, the vent hole being in connection with the insufflationchannel and being adapted to expel the fluid under pressure toinsufflate the abdominal region.
 2. The insufflating surgical instrumentof claim 1, wherein at least one of the tip and the shaft is formed of atransparent material to facilitate visualization of the abdominal walland the abdominal region.
 3. The insufflating surgical instrument ofclaim 1, wherein the shaft and the tip are configured to enableinsertion of a laparoscope.
 4. The insufflating surgical instrument ofclaim 1, wherein the shaft has a lumen extending along the axis betweenthe proximal end and the distal end to enable insertion of thelaparoscope.
 5. The insufflating surgical instrument of claim 1, whereinthe lumen of the shaft and the insufflation channel are separated. 6.The insufflating surgical instrument of claim 1, wherein the lumen ofthe shaft and the insufflation channel are combined as one channel. 7.The insufflating surgical instrument of claim 1, further comprising asecond vent hole being in connection with the insufflation channel andformed along the shaft.
 8. The insufflating surgical instrument of claim1, wherein the tip is blunt.
 9. The insufflating surgical instrument ofclaim 1, wherein the shaft and the tip are integrally formed.
 10. Theinsufflating surgical instrument of claim 1, wherein the vent hole maybe of any geometric shape including round, oval, square and rectangular.11. The insufflating surgical instrument of claim 8, wherein the blunttip further comprises a marker to indicate when the vent hole ispositioned for insufflation.
 12. The insufflating surgical instrument ofclaim 11, wherein the marker indicates the point where the vent hole haspenetrated the abdominal wall.
 13. The insufflating surgical instrumentof claim 3, wherein the shaft further comprises a scope stop to preventthe laparoscope from being inserted too far into the shaft and block atleast one of the insufflation channel and the vent hole.
 14. Theinsufflating surgical instrument of claim 1, further comprising a sealhousing disposed at the proximal end of the shaft.
 15. The insufflatingsurgical instrument of claim 14, wherein the seal housing comprises aseptum seal and a plurality of leaflets forming an instrument seal inthe presence of a laparoscope, and providing a zero seal in the absenceof an instrument.
 16. The insufflating surgical instrument of claim 15,wherein the thickness of the leaflets may be formed to a desireddimension to create a pressure release mechanism that inverts andreleases pressure if the abdominal pressure within the patient undergoesa sudden spike.
 17. The insufflating surgical instrument of claim 8,wherein the blunt tip is hollow.
 18. The insufflating surgicalinstrument of claim 1, wherein at least one of the tip and the shaft isformed of a translucent material.
 19. The insufflating surgicalinstrument of claim 2 or 18, wherein the translucent or transparentmaterial is polycarbonate.
 20. The insufflating surgical instrument ofclaim 15, wherein the septum seal is formed of an elastomeric materialincluding Kraton, silicone and the like.
 21. The insufflating surgicalinstrument of claim 1, wherein the shaft has a diameter ranging fromabout 2 mm to about 5 mm.
 22. The insufflating surgical instrument ofclaim 1, wherein the tip is sharp, pointed or bladed to facilitatepenetration of body tissue.
 23. The insufflating surgical instrument ofclaim 22, wherein the tip is asymmetric.
 24. The insufflating surgicalinstrument of claim 1, wherein the tip is generally domed or conicallyshaped.
 25. The insufflating surgical instrument of claim 24, furthercomprising at least one blade formed on the shaft or the tip.
 26. Theinsufflating surgical instrument of claim 3, further comprising anelastomeric lock placed on the inner diameter of the shaft for lockingthe laparoscope.
 27. The insufflating surgical instrument of claim 26,wherein the laparoscope lock is a silicone O-ring sized and configuredto rotate freely to enable the laparoscope to rotate freely relativewith the shaft.
 28. The insufflating surgical instrument of claim 26,wherein the laparoscope lock is rotationally fixed to prevent thelaparoscope from rotating relative to the shaft.
 29. The insufflatingsurgical instrument of claim 1, wherein the shaft is formed of aflexible sleeve.
 30. An insufflating surgical instrument adapted forpenetrating an abdominal wall to insufflate an abdominal region of apatient, comprising: a cannula comprising a wall forming a lumenextending along an axis between the proximal end and a distal end andadapted for connection to a source of fluid under pressure at theproximal end; and a trocar insertable into and removable from the lumenof the cannula; the trocar comprising: a shaft having a wall forming alumen extending between a proximal end and a distal end; and aninsufflation channel operably connected to allow fluid transfer from thecannula to the trocar; and a tip at the distal end of the shaft adaptedto penetrate tissue and enclosing the distal end of the shaft to preventsurgical instruments from extending through the tip, the tip having atleast one vent hole having a first, closed position during penetrationof the abdominal wall and a second, opened position to expel the fluidunder pressure to insufflate the abdominal region after penetration ofthe abdominal wall.
 31. The insufflating surgical instrument of claim30, wherein the tip is a flip-top that automatically opens upontraversing the abdominal wall.
 32. The insufflating surgical instrumentof claim 31, further comprising a retention member for connecting theshaft and the flip-top.
 33. The insufflating surgical instrument ofclaim 30, wherein the tip is a flapper valve that opens to the secondposition when gas or fluid is introduced at the source and into theinsufflation channel.
 34. The insufflating surgical instrument of claim33, wherein the flapper valve is a reverse flapper valve.
 35. Theinsufflating surgical instrument of claim 33, wherein the flapper valveis a spring-based flapper valve.
 36. The insufflating surgicalinstrument of claim 32, wherein the retention member is one of a spring,a spring wire, an offset hinge or a living hinge.
 37. The insufflatingsurgical instrument of claim 31, wherein the flip-top is a two-pieceflip-top.
 38. The insufflating surgical instrument of claim 31, whereinthe tip comprises at least two petals that reposition to the side of theshaft in the second insufflation position.